Laparoscopic Malabsorption Procedures: Controversies

Abstract

Since Scopinaro published his landmark paper on biliopancreatic bypass for obesity in 1979, this operation, now more commonly known as biliopancreatic diversion (BPD), has been surrounded by controversy (1). It carries perceptions of being more dangerous to perform than other procedures and of having more severe metabolic sequelae. Many surgeons have thought that it should be reserved as a revisional procedure or used to advantage only in the super-obese. But surgeons who perform the operation point to its proven track record in maintaining weight loss, which they cite as the most cogent reason to use BPD as a primary bariatric operation. This dichotomy may be best summed up in a communication by Scopinaro in response to an algorithm for selecting bariatric procedures written by Buchwald (2). Buchwald described the BPD as being popular in Italy. Scopinaro (3) replied, “The BPD was conceived in Italy and is popular everywhere.”